Individual
CYNTHIA M ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1707 N 12TH ST, QUINCY, IL 62301-1355
(217) 222-8641
(217) 222-8578
Mailing address
1707 N 12TH ST, QUINCY, IL 62301-1355
(217) 222-8641
(217) 222-8578
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149009193
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149009193
STATE LICENSE
IL
Enumeration date
02/27/2014
Last updated
02/27/2014
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